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Biomedical subjects

A Stoudemire

Publications and source records attributed to A Stoudemire.

At least 91 records · Page 5Linked to original sources
PubMed1983

Underrecognition of patients' psychosocial distress in a university hospital medical clinic.

Seventeen areas of psychosocial distress were evaluated in 87 university hospital internal medicine clinic patients by a self-administered questionnaire and a psychiatric interview. These patients' internists then predicted the patients' distress level in each area. Their predictions correlated significantly with their patients' self-reports of distress-level problems in only 3 of the 17 areas. Even when the internists felt that they had sufficient information to make an accurate prediction, their perceptions were often erroneous, including evaluations of such areas as suicidal ideation and drug use. These data suggest the need for active psychiatric education components in internal medicine training programs.

Ambulatory Care↗
PubMed1983

When the doctor needs a doctor: special considerations for the physician-patient.

The treatment of an ill or impaired physician may present difficulties not typically encountered in other patients. Potential complications arise from the temptation for physicians to diagnose and treat themselves, their tendency to obtain "informal" consultations regarding personal symptoms, their difficult transition from the role of doctor to that of patient, and the inadvertent assumption of a "VIP" status in the hospital. These difficulties may be increased by the denial of illness by the physicians themselves and their families and colleagues. This denial is partially determined by legal, financial, social, professional, and psychological factors. Specific recommendations on caring for an ill physician are presented.

Denial, Psychological↗
PubMed1982

The borderline personality in the medical setting.

Patients with a borderline personality disorder are notorious for causing problems in medical settings because of their angry, provocative, and often self-destructive behaviors. Such patients may frequently evoke negative, often angry responses in physicians. The diagnosis and effective management of such patients are discussed.

Adult↗
PubMed1981

Delirium induced by topical application of podophyllin: a case report.

The authors describe a patient who developed delirium secondary to the topical absorption of podophyllin; this may be the first known case of delirium after topical application of the drug. Other serious medical and neurological complications of podophyllin poisoning are also discussed.

Administration, Topical↗
PubMedDate not supplied

Aetiology and treatment of neuroleptic malignant syndrome.

The clinical triad of fever, movement disorder, and altered mentation known as NMS represents an infrequent yet highly lethal side effect of neuroleptic therapy. Although awareness and recognition are on the rise, underdiagnosis of the disorder may represent a neglected clinical problem of major proportions considering the number of patients treated with neuroleptics. The recognition of problems such as NMS and tardive dyskinesia point out the need for investigation of low-dose efficacy and neuroleptic serum levels. The idea that neuroleptics are free of severe side effects has created a clinical fallacy that high doses of high potency neuroleptics should be administered to acutely psychotic patients and that low doses of neuroleptics may be used for various diagnostic entities. The emphasis on NMS and its 20% mortality rate should point out that neuroleptics should only be used when clinically indicated to treat psychosis and should be given in the lowest possible dose that achieves antipsychotic effects. Although treatment strategies are still being formulated, aggressive medical care and specific drug therapies exist to reverse the symptoms of this syndrome. With proper education, psychiatrists and other specialists can recognize and treat NMS effectively and thus prevent its malignant outcome.

Humans↗
PubMedDate not supplied

Electroconvulsive therapy--induced hemodynamic changes unmask unsuspected coronary artery disease.

Electroconvulsive therapy (ECT) is known to produce increases in heart rate and blood pressure during seizure activity due to sympathetic stimulation and systemic catecholamine surges. These intense, brief hemodynamic changes can adversely affect myocardial oxygen supply and demand. In patients with compromised myocardial circulation, ECT can unmask undiagnosed cardiac disease. In this case report, ECT was performed on a 64-year-old white male with negative cardiac history. The patient awakened complaining of chest pain and ST wave depression was noted on the electrocardiogram. Cardiology consultation and cardiac catheterization were followed by coronary artery bypass surgery for significant coronary artery stenosis prior to resumption of ECT treatments. The physiological changes that occur during ECT are discussed, as well as pitfalls in evaluation of these patients for ECT treatment.

Blood Pressure↗
PubMedDate not supplied

Bipolar disorder associated with Klinefelter's syndrome and other chromosomal abnormalities.

A patient with bipolar disorder and previously undiagnosed Klinefelter's syndrome presented with acute mania refractory to pharmacotherapy and was successfully treated with electroconvulsive therapy. This case constitutes the 31st case report documenting the coexistence of bipolar disorder with chromosomal anomalies and the 14th such patient with Klinefelter's syndrome. The relevance of this case to understanding the genetics of bipolar disorder is explored through a review of previously published reports of bipolar patients with chromosomal abnormalities. The relatively high incidence of Klinefelter's syndrome among this group of patients is discussed in the context of evidence for linkage of bipolar illness to the X chromosome.

Adult↗
PubMedDate not supplied

Expanding psychopharmacologic treatment options for the depressed medical patient.

Psychopharmacologic treatment of depression in medically ill patients is greatly enhanced by the availability of new antidepressant medications that have low or no anticholinergic, anti-alpha-adrenergic, antihistaminic, and quinidine-like properties. This article discusses the important pharmacodynamic and pharmacokinetic properties of the selective serotonin reuptake inhibitors (fluoxetine, paroxetine, and sertraline), bupropion, venlafaxine, and nefazodone--with an emphasis on their side effects relevant to medical patients as well as important drug interactions. In addition, the safety of these newer medications is compared with that of tricyclics; the role for continued tricyclic use in the medical-psychiatric population is examined; the use of electroconvulsive therapy in medically ill patients who are refractory to antidepressants is also briefly discussed.

Antidepressive Agents↗
PubMedDate not supplied

Psychiatry in medical practice. Implications for the education of primary care physicians in the era of managed care: Part 1.

In an effort to control the costs of mental health care, many medical care systems have emphasized the management of psychiatric illness by primary care physicians and curtailed specialty mental health referrals. While this trend mandates that primary care physicians have expertise in the diagnosis and treatment of psychiatric disorders, evidence indicates that not only are psychiatric disorders underrecognized in primary care settings, but also that treatment is often inadequate and accompanied by less than optimal outcomes. In Part 1 of this 2-part series, representative studies of the epidemiology of psychiatric disorders in primary care are reviewed in addition to data that has documented low rates of recognition and suboptimal management of psychiatric illness. In Part 2, to be published in the January-February 1997 issue of Psychosomatics, a core psychiatric curriculum for primary care physicians will be presented that emphasizes the use of competency-based training modules. Strategies for the development and implementation of these educational training modules will also be discussed.

Family Practice↗
PubMedDate not supplied

Psychiatry in medical practice. Implications for the education of primary care physicians in the era of managed care: Part 2.

In Part 1 of this 2-part series, the epidemiology of psychiatric disorders in primary care settings was reviewed as well as evidence that indicates that these conditions often go underrecognized and undertreated by primary care physicians. Educational studies to improve the psychiatric skills of primary care physicians were also reviewed. In Part 2 of this series, a core curriculum for primary care physicians in the diagnosis and treatment of psychiatric disorders that emphasizes competency-based learning is presented. Recommendations for the development and implementation of these competency-based training modules are offered in the conclusion.

Curriculum↗